Abstract
Childbirth with a skilled attendant is crucial for preventing maternal mortality and is an important opportunity for prevention of mother-to-child transmission of HIV. The Maternity in Migori and AIDS Stigma Study (MAMAS Study) is a prospective mixed-methods investigation conducted in a high HIV prevalence area in rural Kenya, in which we examined the role of women's perceptions of HIV-related stigma during pregnancy in their subsequent utilization of maternity services. From 2007-2009, 1,777 pregnant women with unknown HIV status completed an interviewer-administered questionnaire assessing their perceptions of HIV-related stigma before being offered HIV testing during their first antenatal care visit. After the visit, a sub-sample of women was selected for follow-up (all women who tested HIV-positive or were not tested for HIV, and a random sample of HIV-negative women, n = 598); 411 (69%) were located and completed another questionnaire postpartum. Additional qualitative in-depth interviews with community health workers, childbearing women, and family members (n = 48) aided our interpretation of the quantitative findings and highlighted ways in which HIV-related stigma may influence birth decisions. Qualitative data revealed that health facility birth is commonly viewed as most appropriate for women with pregnancy complications, such as HIV. Thus, women delivering at health facilities face the risk of being labeled as HIV-positive in the community. Our quantitative data revealed that women with higher perceptions of HIV-related stigma (specifically those who held negative attitudes about persons living with HIV) at baseline were subsequently less likely to deliver in a health facility with a skilled attendant, even after adjusting for other known predictors of health facility delivery (adjusted odds ratio = 0.44, 95% CI 0.22-0.88). Our findings point to the urgent need for interventions to reduce HIV-related stigma, not only for improving quality of life among persons living with HIV, but also for better health outcomes among all childbearing women and their families.
Highlights
Each year, approximately 342,900 maternal deaths occur globally, the vast majority in developing countries [1]
Our findings point to the urgent need for interventions to reduce HIV-related stigma, for improving quality of life among persons living with HIV, and for better health outcomes among all childbearing women and their families
Skilled delivery attendance can enhance the effectiveness of interventions for the prevention of mother-to-child transmission (PMTCT) of HIV, as women who give birth with the assistance of a health professional are more likely to receive information about and adhere to antiretroviral drugs [7,8]
Summary
Approximately 342,900 maternal deaths occur globally, the vast majority in developing countries [1]. Increasing skilled delivery attendance is one evidence-based strategy for improving maternal and infant health for all women [5,6]. Nearly 350,000 women die from pregnancy- or childbirth-related complications Almost all these ‘‘maternal’’ deaths occur in developing countries. Most maternal deaths are caused by hemorrhage (severe bleeding after childbirth), post-delivery infections, obstructed (difficult) labor, and blood pressure disorders during pregnancy. All these conditions can be prevented if women have access to adequate reproductive health services and if trained health care workers are present during delivery. In sub-Saharan Africa, infection with HIV (the virus that causes AIDS) is an increasingly important contributor to maternal mortality. HIV infection causes maternal mortality directly by increasing the occurrence of pregnancy complications and indirectly by increasing the susceptibility of pregnant women to malaria, tuberculosis, and other ‘‘opportunistic’’ infections—HIV-positive individuals are highly susceptible to other infections because HIV destroys the immune system
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